About BCDA
Healthcare innovation to support value-based care
Every claim submitted to Medicare contains parts of a bigger story. These insights can get lost as patients move through a complex healthcare system.
Beneficiary Claims Data API (BCDA) helps organizations participating in Alternative Payment Models reach value-based care incentives through accountable, integrated, and person-centered care. As an Application Programming Interface (API), BCDA helps organizations integrate Medicare claims data into their tracking, reporting, and performance systems. When providers learn about services their patients receive across the healthcare landscape, they provide more coordinated care.
What’s in the data
Similar to Claim and Claim Line Feeds (CCLF), BCDA data offers Medicare Parts A, B, and D data, but with key differences in file formatting and update frequency based partly on its foundation in Fast Healthcare Interoperability Resources (FHIR). FHIR standardizes data delivery into more universal categories that are easier for different systems to absorb and understand.
Learn more about using CCLF and BCDA files and mapping data between them with the Data Dictionary.
How BCDA fits into the claims data process
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Medicare enrollee receives care
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Provider submits Medicare claim
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BCDA shares partially adjudicated claims data
2-4 days after submission
Partially adjudicated claims haven’t been fully processed and approved yet. BCDA updates this data daily from the Fiscal Intermediary Standard System (FISS) and Multi-Carrier System (MCS).
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Medicare approves the claims
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BCDA shares adjudicated claims data
Typically 14 days after submission
BCDA receives updated adjudicated claims data from the Chronic Conditions Data Warehouse (CCW) every weekend. In the event of a delay, we'll make an announcement in the BCDA Google Group with updates on when the data will be refreshed.
Keeping pace with future change and innovation
BCDA continues to support CMS efforts to empower patients with access to their own data, encompass future payment models, and prevent fraud, waste, abuse as well as authorization-related claims issues.
Improving timeliness with access to claims during processing
Normally, access to Parts A, B, and D data can be delayed during claims processing (adjudication). BCDA lets provider organizations see “partially-adjudicated” data before waiting for the process to complete.
| Partially adjudicated claims | Fully adjudicated claims |
|---|---|
| Update daily | Update weekly |
| Available to ACO REACH participants only | Available to all eligible model entities |
| Requires v2 | Available with v1 or v2 |
| Partially Adjudicated Claims Data Dictionary | BCDA Data Dictionary |
Read the guide to partially adjudicated claims and their use cases to learn more about:
- Update frequency
- Resource types
- Eligible organizations
- Data Dictionary
Keeping pace with future change and innovation
BCDA continues to support CMS efforts to empower patients with access to their own data, encompass future payment models, and prevent fraud, waste, abuse as well as authorization-related claims issues.
What are the other CMS claims-based FHIR APIs?
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Claims Data to Part D Sponsors
The AB2D API provides stand-alone Prescription Drug Plan sponsors with claims data to enhance the use of medication and improve the long term health of enrollees.
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Blue Button
The Blue Button API enables enrollees to connect their Medicare claims data to the applications, services, and research programs they trust.
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Data at the Point of Care
The Data at the Point of Care (DPC) API enables healthcare providers with claims data to fill in gaps in patient history at the point of care and deliver high-quality care to Medicare enrollees.
